Egyptian Survivors of Sexual Violence Complain of Forensic Examiners Mistreatment
Feature: Isra’ Saleh
" I expected better treatment because I was already hurt, annoyed and frightened "
With these words, Nour Abdullah*, a survivor of sexual violence, describes her experience during her medical examination at the Department of Forensic Medicine in Cairo. She says she had a tough experience that she hasn’t managed to overcome despite undergoing psychotherapy.
The feature Victims Twice, documents violations suffered during forensic examinations in Egypt by women survivors of sexual violence. It also chronicles professional violations by forensic doctors in contradiction with international criteria and domestic regulations outlining the proper treatment of these victims.
The term victim/victims is used in some of the feature’s parts because it’s the legal term describing a survivor/survivors of sexual violence. The feature deals with violations against such survivors during forensic examination, which is a key step in the legal process of sexual violence cases in Egypt.
Between Rape and Forensic Examination... “Rubbing Salt in the Wound”
It’s been five years since Nour was sodomized against her will (an act called by law
by a doctor inside his clinic in 2016. However, she still remembers the incident’s full details, especially since she was forced to recount these details during forensic examination in early 2016.
The recounting violated a message sent to the Department of Forensic Medicine by the Office of the Attorney General – and seen by Nour before she went to the clinic. The Office clearly stated that there was no need for Nour to recount the incident’s full details because a long time had passed since it happened and many pieces of evidence had been lost.
Nour’s complaint was late because the lawyer she went to immediately after the incident refused to file a lawsuit on her behalf. “She asked me to leave, saying, ‘Don’t be the subject of a scandal,’” Nour said. “I didn’t know what to do; also, I was too young and knew that lawyers want money. As far as my experience at the time allowed me, I couldn’t do anything. And, of course, I couldn’t tell my parents.”
She describes her experience with the Department of Forensic Medicine as “rubbing salt into the wound.” She says she wishes that other survivors of sexual violence wouldn’t go through the same experience of double violation if they decide to file lawsuits.
In line with the
National Strategy to Combat Violence against Women 2015-2020,
launched by the Egyptian state in cooperation with the National Council for Women, a program called Improving Criminal Justice Response to Violence against Women was implemented, in cooperation with the UN Office on Drugs and Crime (UNODC), during 2014-2018, with a budget of $2,702,591.
The program was specifically designed to assist Egypt in keeping with its international obligation of due diligence to prevent acts of violence against women and girls, by establishing fair and effective procedures for dealing with cases of violence against women and girls at all stages of the criminal justice process, and by ensuring a survivor/victim-centered approach, including assisting and protecting them, ensuring justice and fairness and punishing perpetrators. This is according to the final report on the project (issued by UNDOC in 2019 as an evaluation of the period from March 2015 to the end of 2018).
According to the report, all forensic doctors in Egypt (a total of 80) were given basic training about violence against women and how to deal with survivors/victims. Also, a trainers’ training course was given to 15 doctors. The report said combatting violence against women “is not a high priority.”
The Department has branches in 21 out of Egypt’s 27 governorates. Forensic Laboratories, which include the DNA testing facilities needed in comparing genetic fingerprints in rape and “indecent assault” cases, aren’t available in all branches.
Forensic Medicine’s Budget
on the national strategy, the National Council for women said, “All forensic doctors (in the field and in laboratories) have been trained on the standards for dealing with violent crimes against women, and members of the judiciary and the Office of the Attorney General have been trained on procedural evidence, which has been prepared specifically for each of them on how to deal with cases of sexual and physical violence.”
However, although forensic doctors have undergone training in dealing with survivors/victims of violence, Nour was subjected to a number of violations by two forensic doctors before they left the examination room at her personal request.
Fragile Referral System
Annually, nearly 20,000 rapes are reported in Egypt, according to a 2017 UK Home Office
It points out that the actual numbers are estimated to be much more.
No official statistics on sexual violence in Egypt are available, as the Ministry of Internal Affairs has stopped publishing the special Public Security Report, which was published annually and included all crimes that have occurred in the country and their geographical distribution. Now the Ministry circulates the report only internally, claiming that this information concerns only those in charge of the security situation, according to lawyer and executive director of the Women’s Center for Guidance and Legal Awareness, Reda El-Danbouki.
El-Danbouki attributes this to the Egyptian government’s desire to “relieve itself of embarrassment and the provision of evidence of inaction in its security enforcement operations and the protection of citizens, both men and women.” He says he sees this as a kind of lack of transparency and lack of access to information, in violation to the Constitution and international conventions.
On the other hand, El-Danbouki says legislators’ recent tendency to toughen sanctions on some violent crimes – such as sexual harassment and female mutilation and their efforts to redefine these crimes from being misdemeanors to felonies is a kind of “flirtation” with the international community, without real interest in enforcement on the ground.
We went to the National Center for Social and Criminal Research, whose library contains the latest publicly available issues of the Public Security Report. The last available issue was published in 2012, and it reported 180 sexual assault offences.
The feature’s writer also reviewed the latest studies by the Central Agency for General Mobilization and Statistics on gender and violence against women in Egypt, but none contained data on sexual violence.
According to Egypt’s Al-Watan electronic portal, the Ministry of Internal Affairs announced part of the 2017 Public Security Report, which revealed that the perpetrators of 2,824 criminal offences had been arrested in 2016. The newspaper ran details of some of these offences, but none included sexual violence crimes.
A research paper published by the American University of Cairo’s Alternative Policy Solutions project in 2020 attributes the lack of access to this data to “the lack of both a uniform national information system in health facilities and national studies on sexual violence.”
It also highlights the absence of “a clear standard operating procedure for referrals between the different departments, for example, emergency rooms, obstetrics and gynecology, psychiatry and forensic medicine.” Moreover, “there are a limited number of forensic doctors, which leads to delays in the collection of physical evidence from survivors. More importantly, the basic psychological care that should be provided for the victims [is neglected]... Moreover, the management of sexual violence survivors is not a part of the curricula at medical schools. Such management is left to the initiative and attitude of individual healthcare providers.”
The referral, according to a 2019 guide by Nazra for Feminist Studies, is “the process by which the needs of survivors of (sexual) violence are identified and assisted to access the forms of support they need from service providers.” On the other hand, a referral system is intended as “the institutional framework that fosters all those who support survivors of violence and ensures communication and cooperation among them in order to protect and support survivors in the process of rehabilitation and empowerment.”
Steps to Refer Survivors to Forensic Medicine in Egypt
Survivors of sexual assaults are subjected to examination at the Department of Forensic Medicine – which is part of the Ministry of Justice – to collect criminal evidence in sexual crimes. If rape is proven, the perpetrator may face capital punishment, according to
The Egyptian legislators list some types of rape under the term “indecent assault,” a crime whose punishment is less severe than that of rape, which itself is described by the Penal Code as “forced lying with someone.”
Articles on Sexual Violence in Egypt’s Penal Code
Whoever lies with a female without her consent shall be punished with execution or life imprisonment.
The felon shall be punished with execution if the victim has not attained 18 full Gregorian years of age, or if the felon is from the victim’s family, or those in charge of rearing, observing or having power over her, or is a paid servant to her or to the aforementioned persons, or if there are more than one felons to the crime.
Whoever indecently assaults a person by force or threat, or attempts such assault shall be punished with aggravated imprisonment.
If the victim of the said crime has not attained 16 Gregorian years of age, or the perpetrator of the crime is among those prescribed in the second clause of Article 267, the punishment is aggravated imprisonment for at least seven years, and if both conditions are met, the felon is sentenced to life imprisonment.
According to the Egyptian legislator, the crime of rape occurs only by inserting the male organ into the female organ, but any acts less than that, such as rape with sharp tools or fingers, or oral or anal rape, all fall under the scope of “indecent assault” rather than rape.
“It Was You Who Wanted This”
In the Neighbourhood of ‘markaz’ in El-Dakahlia Governorate, Amal Ashraf* was raped by a classmate in 2019. When the Office of the Attorney General decided that she should undergo forensic examination, she had to travel for 1.5 hours to the city of Al-Mansoura because the Department of Forensic Medicine didn’t have a branch at the ‘markaz.’
We talked to Amal’s mother, who told us that she wanted a female doctor to examine her daughter because the situation was sensitive. But since no female doctors were available at the time, a male doctor was in charge of the examination. He refused to let the mother attend, arguing that he would ask the girl “embarrassing questions” that she may refuse to answer in front of her mother. He also told the mother that a female nurse would attend the whole examination.
The mother was filled with sorrow when Amal went out of the examination room crying. The girl said the doctor insulted her by verbally abusing and stigmatizing her by saying to her, “It was you who wanted this.” He hinted that the sexual intercourse took place with her consent, although he admitted in his final report that she was raped.
“I should have been with her, no?” the mother asks. “I didn’t know whether he was right or wrong... when he told me that he might ask her questions and that she would be embarrassed to answer. But when she went out in tears, I was sad because I hadn’t insisted on being with her during the examination.”
The mother wished she could be beside her daughter to give her some sense of security that wasn’t available at the examiner’s clinic. Also, the nurse didn’t attend the whole examination, as the doctor had promised; “she kept coming in and out.”
The doctor didn’t ask the survivor for permission to carry out the examination; he didn’t explain to her what he was going to do; he carried out the whole process without her consent. He touched her body and didn’t wear a hairnet while examining her.
The doctor treated Amal as guilty, although she was the victim. “They believe that such girls aren’t decent and that they consented to having sex,” her mother says. “My daughter told me she felt despised. She said the doctor didn’t give her a chance to... he treated her as if she had had fun.” In addition, the doctor’s comments to the survivor were stigmatizing, including: “It was you who wanted this;” “You did this;” “Why did you do this?”
The mother cries, rejecting any blame to her daughter, who survived an assault but hasn’t overcome it yet. “He shouldn’t make her feel cheap, dirty or like a street girl... He should’ve told her that he’d help her in her quest for justice. Social stigma is already too much; a doctor should be someone wise and sensitive.”
The mother was also worried that her daughter might suffer another psychological shock, especially that she attempted suicide after the rape incident. “I feared that she, having left the examination room feeling bad and depressed, might hurt herself. I was worried she could poison herself.”
“The Problem Is In The System”
Some women activists and workers in Egyptian women’s groups and institutions believe that the problem begins from the moment of the referral and isn’t restricted to the forensic examination phase.
Hiba Adel, a lawyer and chairwoman of the board of trustees at the Egyptian Women’s Rights Initiative, calls for training on violence cases in all referral stages – from police departments and offices of attorneys general and investigators to the courts themselves. This prompted a task force of nine human rights and women’s organizations to prepare a proposal for a uniform law to deal with violence against women, which contains a full section on litigation proceedings and emphasizes the speedy referral of victims of violence, particularly in sexual offences, to avoid the loss of evidence.
Member of Parliament Nadia Henry, endorsed the proposal in the previous parliamentary session (legislative season 2016-2021), and about 60 deputies joined her by signing the document. But the proposal hasn’t yet been presented to the Legislative Committee and hasn’t yet been discussed.
Moreover, according to Adel, there was pressure to amend certain Penal Code articles and eliminate others, such as the ones dealing with marital rape. At the end of the session, the proposal was shelved, despite continuing attempts to present it for discussion during the current session.
Articles on Litigation in the Proposed Uniform Law to Fight Violence against Women
The Police Department shall have a specialized unit to receive complaints and research and investigate violent crimes against women in accordance with the provisions of this law. This unit shall include women trained to deal in cases of violence against women, with the admission of voice and video recording of the interview to the investigation. Such investigation shall be conducted only in the presence of the victim’s lawyer and a female social worker.
When receiving complaints and communications, the competent police unit:
Listens to witnesses of violence, including minors, in the presence of the social worker.
Speeds up the referral of victims of violence to free medical examination or a criminal laboratory that specializes in dealing with sexual offences.
- Adopts videos and images that capture the act of violence for reference only.
Sections at lower courts shall be dedicated to hearing cases relating to crimes of violence against women and special attorneys general shall be tasked with investigating complaints about acts of violence committed against women.
Despite calls to amend Egypt’s referral system to be more responsive to cases of violence, particularly with regard to sexual offences, there are international and local standards to be followed during healthcare provision and forensic evidence collection with respect to female survivors/victims of sexual violence through the use of global and local sources.
Among the most prominent of these sources are the Guidelines for Medico-Legal Care for Victims of Sexual Violence (issued by the World Health Organization (WHO) in 2011) and the Medical Protocol/Guidelines for Management of Victims of Gender Based Violence (Including Sexual Violence) (issued by the UN Population Fund (UNFPA) in cooperation with the Ministry of Health and Population).
- Informed Consent
- Consent Form
- Explain the kind of examination/steps
- Wearing Gloves and Hairnet
- Swabs and Samples
- Confidentiality (1)
- Confidentiality (2)
- A Female Nurse’s Presence
- Companion’s Presence (1)
- Companion’s Presence (2)
- Examining Both Parties
- Incident Description (1)
- Incident Description (2)
- Consent to Evidence Collection
Informed consent, where the patient (or parent or guardian) is expected to be informed of all relevant issues to help the victims make a decision.Types of ViolationsGeneral consent of examination sought at the Office of the Attorney General and no consent is sought during examination.
A form for informed consent of the examination’s steps and signing it before the examination begins.Types of ViolationsThere’s no consent form.
Explain the kind of examination/steps
All examination steps must be explained to the survivor; it should also be explained that genital/anal examination will require the survivor to lie down in a position that allows the examiner to see this area properly with the right lighting; for example: “I’ll ask you to lie down on your back on the examination bed with the sheet on your knees. I’m going to ask you to lift your knees up, to put your ankles together and to separate your legs so I can see the pelvic area with the help of this light.”Types of ViolationsDealing violently with the victim during the examination, such as bending her body into the required positions without her consent.
The type of questions asked and the reasons for asking them; for example: “I would like to ask you about the details of the assault. I want to know where the attacker’s body touched your body so I can find out where to look in your body for signs of injury or traces of evidence left by your attacker.”
Avoiding questions that start with the question “Why?” It involves blame. Avoiding using words that blame the victim, such as: “What did you expect to happen otherwise?” Or “What were you doing alone there?” Or “What were you wearing?” Or “You should have been more careful.”Types of ViolationsAsking personal questions and blaming the victim.
The examination must be carried out in conditions that maintain the survivor’s privacy and dignity.Types of ViolationsExamination places sometimes don’t take privacy into account.
Wearing Gloves and Hairnet
Wearing gloves and hairnet during the examination to protect criminal evidence.Types of ViolationsGloves and hairnet aren’t worn sometimes, possibly leading to evidence corruption.
Swabs and Samples
Collecting body materials such as hair, pubic hair, genital secretions, blood, urine and saliva. Clothes may be collected, too.Types of ViolationsBlood samples are rarely collected, and there’s no guidance for the survivor to retain the required evidence.
The survivor must be told that the information obtained from her and discovered during the examination by the health worker will be passed on to investigators for use in criminal justice proceedings if she decides to continue with the criminal proceedings, which require reporting. This means that anything a health worker is told about may not remain confidential between the patient and the health worker; it may be discussed in an open court sometime in the future.Types of ViolationsThis isn’t clarified.
Assuring the victim that the information she would give and the results of the examination would be confidential.Types of ViolationsConfidentiality isn’t underscored.
The survivor should be told if the examination will include photography and how the photographs will be used.Types of ViolationsNo violation.
A Female Nurse’s Presence
The examination should only take place if a female nurse is present. Otherwise, it shouldn’t take place.Types of ViolationsSometimes examinations take place without a female nurse.
If there’s no female nurse, a companion of the same sex as the survivor should be present.Types of ViolationsSometimes mothers aren’t allowed to accompany survivors.
A female companion should be always with the victim, especially if the examiner is a man.Types of ViolationsSometimes examinations take place without a female companion.
All previous information must be provided in easy-to-understand language to the survivor, her parents or guardian.Types of ViolationsMostly, no information is shared with the patient, even if she asks for it.
Examining Both Parties
The same doctor shouldn’t sign the examinations of both parties – the assailant and the assailed.Types of ViolationsBecause of a shortage in doctors, the same doctor signs the examinations of both parties.
The victim should be asked to tell the examiner what happened in her words and style. The examiner should write down what the victim says and avoid unnecessary interpretations; if the examiner needs further explanations, they should ask the patient questions after she’s done talking. The examiner should be systematic and take into consideration that some victims/survivors may intentionally avoid mentioning some details, especially embarrassing ones, about the assault. (For example: The victim may avoid talking about oral or anal intercourse).Types of ViolationsThe survivor is insistingly pressured to mention some details, including ones outside the examination’s scope.
- Asking the victim to describe the incident and letting her speak the way she chooses.
- Not interrupting her or asking her to go into details; this should be left until she finishes telling her story.
- Taking into consideration that the victim may not mention some issues or details because they’re too sensitive. But since some details may entail certain treatment procedures, including prescribing emergency contraception or preventing HIV infection, the examiner must tell the victim that what she may reveal will remain confidential. The examiner should ask the victim to tell details but without pressuring her.Types of ViolationsThe survivor is insistingly pressured to mention some details, including ones outside the examination’s scope.
Consent to Evidence Collection
The survivor’s consent should be obtained for evidence collection before the procedure begins. In Egypt, evidence collection is the job of the Department of Forensic Medicine, which is part of the Ministry of Justice. All evidence collected is only sent to the competent authorities if the victim wishes to continue the legal proceedings.Types of ViolationsNo consent is taken before evidence collection.
Dr. Dina Shukri, professor of forensic medicine at Cairo University, comments on the lack of monitoring mechanisms within the Department of Forensic Medicine, noting that the problem isn’t in legal rules and texts but in implementation, monitoring and impact-tracking mechanisms.
The Medical Protocol/Guidelines for Management of Victims of Gender Based Violence, issued in November 2014, provides a comprehensive guide for detailing with survivors of violence of all sorts during all referral stages and focuses on psychological and social dimensions.
But although this guide, which she co-prepared and co-circulated to many healthcare providers in Egypt – not just forensic examiners – remains non-binding. It depends solely on the personal commitment of each professional, without a genuine accountability system that ensures proper standards in dealing with survivors/victims of violence. Also absent is any guarantee of long-term applicability.
Prejudgments and “Non-Humane” Treatment
El-Danbouki, the lawyer, describes the treatment of survivors during forensic examinations as “non-humane,” saying it makes them feel humiliated and insecure. The doctor examines the victim’s body without her consent, sometimes even asking her to take off her clothes completely, while the message of the Office of the Attorney General specifies that a certain part to be examined in accordance with the survivor/victim’s complaint.
He points out that the waiting rooms don’t “at all” meet privacy standards. The survivor often has no awareness of what’s happening, and doesn’t know what’s right or wrong, he says. She has to submit to the doctor without the ability to agree or reject, because in the end “she’s helpless,” he adds, stressing that some survivors don’t pursue their cases further because of what they’re exposed to during forensic examinations.
Human rights lawyer Michael Rauf agrees with El-Danbouki, asserting that the treatment of survivors in forensic examinations is sometimes “very rough and confrontational,” as if the survivor were the “accused, not the victim.” Doctors overly interfere unnecessarily with the details of the assault and blame the survivor, he adds.
Rauf points out that the forensic team is still not fully qualified to deal with a “rape victim,” so the examination step becomes “heavy and harmful to her.” While the examination is theoretically optional, if the survivor rejects it, it will harm her case, so it is somehow mandatory, he explains.
We tried several times to talk to the Central Administration of the Department of Forensic Medicine in Cairo. We sent an official message and made several phone calls. But the department’s head refused to be interviewed by the media, asking the feature’s writer to contact the Minister of Justice’s assistant for the affairs of forensic experts and medicine.
The feature’s writer talked to Dr. Nadia Qutb, professor of forensic medicine and poisonous materials in Qasr El-Aini Medical School. Qutb effectively confirms that the girl’s clothes and appearance may be an evidence on which the forensic doctor relies to decide whether or not to admit the incident. Other evidence “directs the doctor,” too, she says. She also told us, “from experience, we can judge the patient’s words, emotions and responses to us.”
For example, the girl’s clothes and makeup can help judge if she “is used to sexual intercourse, hence, her claims are maybe false.” Also, the way she talks and reacts – if she’s “bold, rude or shy” – can help forensic doctors judge if she was assaulted or not. If assaulted, she should “feel shy and ashamed” or appear “stunned and traumatized,” but if she overreacts in her anger, the whole thing is more likely to be an “act,” the forensic medicine professor explains.
She further added that if the girl is more than 18 years of age, she would become responsible for herself, and therefore if she showed no signs of resistance during the examination, she would be judged to have had consensual sex and that there was no alleged crime.
It is worth mentioning that the forensic medical examination of Nour was carried out at the central department’s branch in Zeinhom, Cairo, where a clinic specialized in cases of sexual violence was established in 2017, supposedly “equipped with capabilities and staff trained to deal with this type of cases,” according to the official website of the Department of Forensic Medicine.
Through the UNODC project, the Department of Forensic Medicine has also equipped clinics in Cairo, Alexandria and Mansoura to be better able to detect and document evidence in cases of sexual assault. The same applies to the Tanta clinic, but it wasn’t ready at the time of the project’s evaluation.
The culture of blaming survivors, which continues to be entrenched in Egyptian society, isn’t limited to private circles, but also extends to official justice agencies and institutions. Guidelines and efforts (to explain appropriate procedures) often remain ink on paper, and until they’re accompanied by a genuine will to change how violence against women is being handled and achieve justice and equity for them, the situation will remain the same.
“When girl says she’s going for forensic examination, I want her to be doing so to prove that she’s been hurt, not to be hurt there,” Nour says. She and many other survivors are still paying heavy physical and psychological price for violence in social and institutional contexts that make them “victims twice.”
The feature used pseudonyms to protect the privacy of sexual violence survivors and their personal security.